Management of benign nodular thyroid disease:a nationwide survey of endocrine specialists in Spain.

Abstract

Background: Management of benign nodular thyroid disease (BNTD) has changed dramatically over the past two decades as reflected by international guidelines recommendations.

Purpose: We sought to document the preferences regarding the management of euthyroid BNTD among thyroid dedicated members of the Spanish Society of Endocrinology and Nutrition (SEEN) and assess the extent to which present international guidelines recommendations have been incorporated into ordinary practice.

Methods: Online survey on the management of a standard case of BNTD among SEEN thyroid experts and explore of variations in management following different clinical scenarios in which variables such as sex, age, ultrasound characteristics, fine needle aspiration results or patient preferences change.

Results: Two hundred and eleven (9% of the SEEN members) participated in the survey. Most of them, 147 (69.7%), recommended periodic monitoring, 43 (20.3%) surgery and 21 (10.0%) minimally invasive procedures (MIP). No participant opted for levothyroxine or radioiodine. Management of BNTD was modified based on patient preferences, both in favour of more aggressive (surgery) and more conservative (MIP or monitoring) options.

Conclusions: The vast majority of Spanish thyroidologists followed the international guidelines recommendations for BNTD management. The trend shows the positive impact of the guidelines' recommendations with a shift towards more conservative management and taking into account patient preference as a binding element in therapeutic decision-making.